Provider Demographics
NPI:1568715860
Name:SMALLS, JAMILLAH MONIQUE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:JAMILLAH
Middle Name:MONIQUE
Last Name:SMALLS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 RED TIP CIR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-3943
Mailing Address - Country:US
Mailing Address - Phone:843-669-0098
Mailing Address - Fax:
Practice Address - Street 1:300 N CEDAR ST
Practice Address - Street 2:SUITE D
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6433
Practice Address - Country:US
Practice Address - Phone:843-832-4265
Practice Address - Fax:843-875-6026
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6365104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6365OtherBOARD OF SOCIAL WORK EXAMINERS